Prognostic nomogram for patients with unresectable pancreatic cancer treated with gemcitabine plus nab–paclitaxel or FOLFIRINOX: A post–hoc analysis of a multicenter retrospective study in Japan (NAPOLEON study)
Taro Shibuki,
Toshihiko Mizuta,
Mototsugu Shimokawa,
Futa Koga,
Yujiro Ueda,
Junichi Nakazawa,
Azusa Komori,
Satoshi Otsu,
Shiho Arima,
Masaru Fukahori,
Akitaka Makiyama,
Hiroki Taguchi,
Takuya Honda,
Kenji Mitsugi,
Kenta Nio,
Yasushi Ide,
Norio Ureshino,
Tsuyoshi Shirakawa,
Taiga Otsuka
Affiliations
Taro Shibuki
Department of Internal Medicine, Imari Arita Kyoritsu Hospital
Toshihiko Mizuta
Department of Internal Medicine, Imari Arita Kyoritsu Hospital
Mototsugu Shimokawa
Clinical Research Institute, National Hospital Organization Kyushu Cancer Center
Futa Koga
Department of Hepatobiliary and Pancreatology, Saga Medical Center Koseikan
Yujiro Ueda
Department of Hematology and Oncology, Japanese Red Cross Kumamoto Hospital
Junichi Nakazawa
Department of Medical Oncology, Kagoshima City Hospital
Azusa Komori
Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
Satoshi Otsu
Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
Shiho Arima
Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences
Masaru Fukahori
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
Akitaka Makiyama
Department of Hematology/Oncology, Japan Community Healthcare Organization Kyushu Hospital
Hiroki Taguchi
Department of Gastroenterology, Saiseikai Sendai Hospital
Takuya Honda
Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences
Kenji Mitsugi
Department of Medical Oncology, Hamanomachi Hospital
Kenta Nio
Department of Medical Oncology, Hamanomachi Hospital
Yasushi Ide
Department of Internal Medicine, Karatsu Red Cross Hospital
Norio Ureshino
Department of Medical Oncology, Saga Medical Center Koseikan
Tsuyoshi Shirakawa
Department of Medical Oncology, Fukuoka Wajiro Hospital
Taiga Otsuka
Department of Medical Oncology, Saga Medical Center Koseikan
Abstract Background No reliable nomogram has been developed until date for predicting the survival in patients with unresectable pancreatic cancer undergoing treatment with gemcitabine plus nab–paclitaxel (GnP) or FOLFIRINOX. Methods This analysis was conducted using clinical data of Japanese patients with unresectable pancreatic cancer undergoing GnP or FOLFIRINOX treatment obtained from a multicenter study (NAPOLEON study). A Cox proportional hazards model was used to identify the independent prognostic factors. A nomogram to predict 6–, 12–, and 18–month survival probabilities was generated, validated by using the concordance index (C–index), and calibrated by the bootstrapping method. And then, we attempted risk stratification for survival by classifying the patients according to the sum of the scores on the nomogram (total nomogram points). Results A total of 318 patients were enrolled. A prognostic nomogram was generated using data on the Eastern Cooperative Oncology Group performance status, liver metastasis, serum LDH, serum CRP, and serum CA19–9. The C–indexes of the nomogram were 0.77, 0.72 and 0.70 for 6–, 12–, and 18–month survival, respectively. The calibration plot showed optimal agreement at all points. Risk stratification based on tertiles of the total nomogram points yielded clear separations of the survival curves. The median survival times in the low–, moderate–, and high–risk groups were 15.8, 12.8 and 7.8 months (P<0.05), respectively. Conclusions Our nomogram might be a convenient and inexpensive tool to accurately predict survival in Japanese patients with unresectable pancreatic cancer undergoing treatment with GnP or FOLFIRINOX, and will help clinicians in selecting appropriate therapeutic strategies for individualized management.
